![NTT East kantou hospiutal](https://upload.wikimedia.org/wikipedia/commons/2/20/NTT_East_kantou_hospiutal.JPG)
The health care system in Japan provides
healthcare
Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...
services, including screening examinations,
prenatal care
Prenatal care, also known as antenatal care, is a type of preventive healthcare. It is provided in the form of medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as materna ...
and
infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
control, with the patient accepting responsibility for 30% of these costs while the government pays the remaining 70%. Payment for personal medical services is offered by a
universal health care
Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized ar ...
insurance system that provides relative equality of access, with fees set by a government committee. All residents of
Japan
Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the north ...
are required by the law to have health insurance coverage. People without insurance from employers can participate in a national
health insurance
Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
program, administered by local governments. Patients are free to select physicians or facilities of their choice and cannot be denied coverage. Hospitals, by law, must be run as non-profit and be managed by physicians.
Medical fees are strictly regulated by the government to keep them affordable. Depending on the family’s income and the age of the insured, patients are responsible for paying 10%, 20%, or 30% of medical fees, with the government paying the remaining fee. Also, monthly thresholds are set for each household, again depending on income and age, and medical fees exceeding the threshold are waived or reimbursed by the government.
Uninsured patients are responsible for paying 100% of their medical fees, but fees are waived for low-income households receiving a government subsidy.
History
![National Cancer Center Hospital](https://upload.wikimedia.org/wikipedia/commons/f/fc/National_Cancer_Center_Hospital.jpg)
The modern Japanese Health care system started to develop just after the Meiji Restoration with the introduction of Western medicine. The statutory insurance, however, had not been established until 1927 when the first employee health insurance plan was created.
[ Kōdansha 1993, p. 338.]
In 1961, Japan achieved universal health insurance coverage, and almost everyone became insured. However, the copayment rates differed greatly. While those who enrolled in employees' health insurance needed to pay only a nominal amount at the first physician visit, their dependents and those who enrolled in National Health Insurance had to pay 50% of the fee schedule price for all services and medications. From 1961 to 1982, the copayment rate was gradually lowered to 30%.
Since 1983, all elderly persons have been covered by government-sponsored insurance.
In the late 1980s, government and professional circles were considering changing the system so that primary, secondary, and tertiary levels of care would be clearly distinguished within each geographical region. Further, facilities would be designated by level of care and referrals would be required to obtain more complex care. Policy makers and administrators also recognized the need to unify the various insurance systems and to control costs.
By the early 1990s, there were more than 1,000
mental hospital
Psychiatric hospitals, also known as mental health hospitals, behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, such as schizophrenia, bipolar disorder, eating disorders, dissociati ...
s, 8,700 general
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
s, and 1,000 comprehensive hospitals with a total capacity of 1.5 million beds. Hospitals provided both out-patient and in-patient care. In addition, 79,000
clinic
A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs ...
s offered primarily out-patient services, and there were 48,000
dental clinics
Dental may refer to:
* Dental consonant, in phonetics
* Dental Records, an independent UK record label
* Dentistry, oral medicine
* Teeth
See also
*
* Dental care (disambiguation)
* Dentist (disambiguation)
A dentist is a practitioner of denti ...
. Most
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
s and
hospital
A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...
s sold medication directly to patients, but there were 36,000
pharmacies
Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links heal ...
where patients could purchase synthetic or herbal medication.
National health expenditures rose from about 1 trillion
yen
The is the official currency of Japan. It is the third-most traded currency in the foreign exchange market, after the United States dollar (US$) and the euro. It is also widely used as a third reserve currency after the US dollar and the e ...
in 1965 to nearly 20 trillion yen in 1989, or from slightly more than 5% to more than 6% of Japan's national income.
One problem has been an uneven distribution of health personnel, with rural areas favored over cities.
In the early 1990s, there were nearly 191,400 physicians, 66,800
dentist
A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry (the diagnosis, prevention, management, and treatment of diseases and conditions of the mouth, oral cavity and other aspects of the craniofaci ...
s, and 333,000
nurse
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...
s, plus more than 200,000 people licensed to practice
massage
Massage is the manipulation of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet or a device. The purpose of massage is generally for the treatment of body stress or pain. In Eu ...
,
acupuncture
Acupuncture is a form of alternative medicine and a component of traditional Chinese medicine (TCM) in which thin needles are inserted into the body. Acupuncture is a pseudoscience; the theories and practices of TCM are not based on scientifi ...
,
moxibustion
Moxibustion () is a traditional Chinese medicine therapy which consists of burning dried mugwort ('' wikt:moxa'') on particular points on the body. It plays an important role in the traditional medical systems of China, Japan, Korea, Vietnam, ...
, and other East Asian therapeutic methods.
Cost
![Life expectancy vs spending OECD](https://upload.wikimedia.org/wikipedia/commons/f/fc/Life_expectancy_vs_spending_OECD.png)
In 2008, Japan spent about 8.2% of the nation's gross domestic product (GDP), or US$2,859.7 per capita, on health, ranking 20th among Organization for Economic Cooperation and Development (OECD) countries. The share of gross domestic products was same as the average of OECD states in 2008.
According to 2018 data, share of gross domestic products rose to 10.9% of GDP, overtaking the OECD average of 8.8%.
The government has controlled cost over decades using the national uniform fee schedule for reimbursement. The government is also able to reduce fees when the economy stagnates.
In the 1980s, health care spending was rapidly increasing as was the case with many industrialized nations. While some countries like the U.S. allowed costs to rise, Japan tightly regulated the health industry to rein in costs.
Fees for all health care services are set every two years by negotiations between the health ministry and physicians. The negotiations determine the fee for every medical procedure and medication, and fees are identical across the country. If physicians attempt to game the system by ordering more procedures to generate income, the government may lower the fees for those procedures at the next round of fee setting.
This was the case when the fee for an MRI was lowered by 35% in 2002 by the government.
Thus, as of 2009, in the U.S. an MRI of the neck region could cost $1,500, but in Japan it cost US$98.
Once a patient's monthly copayment reaches a cap, no further copayment is required. The threshold for the monthly copayment amount is tiered into three levels according to income and age.
In order to cut costs, Japan uses generic drugs. As of 2010, Japan had a goal of adding more drugs to the nations National Health Insurance listing. Age related conditions remain one of the biggest concerns. Pharmaceutical companies focus on marketing and research toward that part of the population.
Provision
![Practising Physicians per Capita in Japan](https://upload.wikimedia.org/wikipedia/commons/8/88/Practising_Physicians_per_Capita_in_Japan.JPG)
People in Japan have the longest
life expectancy at birth
Life is a quality that distinguishes matter that has biological processes, such as signaling and self-sustaining processes, from that which does not, and is defined by the capacity for growth, reaction to stimuli, metabolism, energy transf ...
of those in any country in the world. Life expectancy at birth was 83 years in 2009 (male 79.6 years, female 86.4 years).
This was achieved in a fairly short time through a rapid reduction in mortality rates secondary to communicable diseases from the 1950s to the early 1960s, followed by a large reduction in stroke mortality rates after the mid-60s.
In 2008 the number of acute care beds per 1000 total population was 8.1, which was higher than in other OECD countries such as the U.S. (2.7).
Comparisons based on this number may be difficult to make, however, since 34% of patients were admitted to hospitals for longer than 30 days even in beds that were classified as acute care. Staffing per bed is very low. There are four times more MRI scanners per head, and six times the number of CT scanners, compared with the average European provision. The average patient visits a doctor 13 times a year - more than double the average for OECD countries.
In 2008 per 1000 population, the number of practicing physicians was 2.2, which was almost the same as that in U.S. (2.4), and the number of practicing nurses was 9.5, which was a little lower than that in U.S. (10.8), and almost the same as that in UK (9.5) or in Canada (9.2).
Physicians and nurses are licensed for life with no requirement for license renewal, continuing medical or nursing education, and no peer or utilization review. OECD data lists specialists and generalists together for Japan
because these two are not officially differentiated. Traditionally, physicians have been trained to become subspecialists, but once they have completed their training, only a few have continued to practice as subspecialists. The rest have left the large hospitals to practice in small community hospitals or open their own clinics without any formal retraining as general practitioners.
Unlike many countries, there is no system of general practitioners in Japan, instead patients go straight to specialists, often working in clinics.
Quality
Japanese outcomes for high level medical treatment of physical health is generally competitive with that of the US. A comparison of two reports in the ''New England Journal of Medicine'' by MacDonald et al. (2001) and Sakuramoto et al.(2007) suggest that outcomes for gastro-esophageal cancer is better in Japan than the US in both patients treated with surgery alone and surgery followed by chemotherapy. Japan excels in the five-year survival rates of colon cancer, lung cancer, pancreatic cancer and liver cancer based on the comparison of a report by the American Association of Oncology and another report by the Japan Foundation for the Promotion of Cancer research. The same comparison shows that the US excels in the five-year survival of rectal cancer, breast cancer, prostate cancer and malignant lymphoma. Surgical outcomes tend to be better in Japan for most cancers while overall survival tend to be longer in the US due to the more aggressive use of chemotherapy in late stage cancers. A comparison of the data from United States Renal Data System (USRDS) 2009 and Japan Renology Society 2009 shows that the annual mortality of patients undergoing dialysis in Japan is 13% compared to 22.4% in the US. Five-year survival of patients under dialysis is 59.9% in Japan and 38% in the US.
In an article titled "Does Japanese Coronary Artery Bypass Grafting Qualify as a Global Leader?" Masami Ochi of
Nippon Medical School
is a private university in Sendagi (), Bunkyo-ku, Tokyo, Japan.
History
In 1876, Tai Hasegawa () established a medical school in Tokyo. At that time, the Japanese government and the Ministry of Education only permitted one medical school: th ...
points out that Japanese coronary bypass surgeries surpass those of other countries in multiple criteria. According to the International Association of Heart and Lung Transplantation, the five-year survival of heart transplant recipients around the world who had their heart transplants between 1992 and 2009 was 71.9% (ISHLT 2011.6) while the five-year survival of Japanese heart transplant recipients is 96.2% according to a report by Osaka University. However, only 120 heart transplants have been performed domestically by 2011 due to a lack of donors.
In contrast to physical health care, the quality of mental health care in Japan is relatively low compared to most other developed countries. Despite reforms, Japan's psychiatric hospitals continue to largely rely on outdated methods of patient control, with their rates of compulsory medication, isolation (solitary confinement) and
physical restraints (tying patients to beds) much higher than in other countries. High levels of deep vein thrombosis have been found in restrained patients in Japan, which can lead to disability and death. Rather than decreasing the use of restraints as has been done in many other countries, the incidence of use of
medical restraints
Medical restraints are physical restraints used during certain medical procedures to restrain patients with (supposedly) the minimum of discomfort and pain and to prevent them from injuring themselves or others. Rationale
There are many kinds of m ...
in Japanese hospitals doubled in the nearly ten years from 2003 (5,109 restrained patients) through 2014 (10,682).
The 47 local government prefectures have some responsibility for overseeing the quality of health care, but there is no systematic collection of treatment or outcome data. They oversee annual hospital inspections. The Japan Council for Quality Health Care accredits about 25% of hospitals. One problem with the quality of Japanese medical care is the lack of transparency when medical errors occur. In 2015 Japan introduced a law to require hospitals to conduct reviews of patient care for any unexpected deaths, and to provide the reports to the next of kin and a third party organization. However, it is up to the hospital to decide whether the death was unexpected. Neither patients nor the patients' families are allowed to request reviews, which makes the system ineffective. Meanwhile, Japanese healthcare providers are reluctant to provide open information because Japanese medical journalists tend to embellish, sensationalize, and in some cases fabricate anti-medical criticisms with little recourse for medical providers to correct the false claims once they have been made. However, the increased number of hospital visits per capita compared to other nations and the generally good overall outcome suggests the rate of adverse medical events are not higher than in other countries.
It is important to have efficiency in sending patients to the correct medical location because there is an under-staffing problem. Around 92% of hospitals in Japan have an insufficient number of doctors while having sufficient nurses. While only 10% of hospitals have a sufficient number of doctors and an insufficient number of nurses.
A no-fault approach to cases of children born with
cerebral palsy
Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensa ...
was introduced in 2009. This led to a reduction in litigation and 25% fewer children born with the condition.
Access
![Superambulance-fuso](https://upload.wikimedia.org/wikipedia/commons/f/fc/Superambulance-fuso.jpg)
In Japan, services are provided either through regional/national public hospitals or through private hospitals/clinics, and patients have universal access to any facility, though hospitals tend to charge more to those patients without a referral. As above, costs in Japan tend to be quite low compared to those in other developed countries, but utilization rates are much higher. Most one doctor clinics do not require reservations and same day appointments are the rule rather than the exception. Japanese patients favor medical technology such as CT scans and MRIs, and they receive MRIs at a per capita rate 8 times higher than the British and twice as high as Americans.
In most cases, CT scans, MRIs and many other tests do not require waiting periods. Japan has about three times as many hospitals per capita as the US
and, on average, Japanese people visit the hospital more than four times as often as the average American.
Access to medical facilities is sometimes abused. Some patients with mild illnesses tend to go straight to hospital
emergency departments
An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pati ...
rather than accessing more appropriate primary care services. This causes a delay in helping people who have more urgent and severe conditions who need to be treated in the hospital environment. There is also a problem with misuse of ambulance services, with many people taking ambulances to hospitals with minor issues not requiring an ambulance. In turn this causes delays for ambulances arriving to serious emergencies. Nearly 50% of the ambulance rides in 2014 were minor conditions where citizens could have taken a taxi instead of an ambulance to get treated.
Due to the issue of large numbers of people visiting hospitals for relatively minor problems, shortage of medical resources can be an issue in some regions. The problem has become a wide concern in Japan, particularly in Tokyo. A report has shown that more than 14,000 emergency patients were rejected at least three times by hospitals in Japan before getting treatment. A government survey for 2007, which got a lot of attention when it was released in 2009, cited several such incidents in the Tokyo area, including the case of an elderly man who was turned away by 14 hospitals before dying 90 minutes after being finally admitted,
and that of a pregnant woman complaining of a severe headache being refused admission to seven Tokyo hospitals and later dying of an undiagnosed
brain hemorrhage
Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into the tissues of the brain, into its ventricles, or into both. It is one kind of bleed ...
after giving birth.
The so-called "tarai mawashi" (ambulances being rejected by multiple hospitals before an emergency patient is admitted) has been attributed to several factors such as medical imbursements set so low that hospitals need to maintain very high occupancy rates in order to stay solvent, hospital stays being cheaper for the patient than low cost hotels, the shortage of specialist doctors and low risk patients with minimal need for treatment flooding the system.
Insurance
Health insurance is, in principle, mandatory for residents of Japan, but there is no penalty for the 10% of individuals who choose not to comply, making it optional in practice.
There is a total of eight health insurance systems in Japan,
with around 3,500 health insurers. According to
Mark Britnell
Mark Douglas Britnell (born 5 January 1966) is an English business executive. He is a senior partner at the professional services firm KPMG and a global healthcare expert. He was the chairman and senior partner for healthcare, government and infras ...
, it is widely recognised that there are too many small insurers.
They can be divided into two categories, and . Employees’ Health Insurance is broken down into the following systems:
*Union Managed Health Insurance
*Government Managed Health Insurance
*Seaman’s Insurance
*National Public Workers Mutual Aid Association Insurance
*Local Public Workers Mutual Aid Association Insurance
*Private School Teachers’ and Employees’ Mutual Aid Association Insurance
National Health Insurance
National health insurance (NHI), sometimes called statutory health insurance (SHI), is a system of health insurance that insures a national population against the costs of health care. It may be administered by the public sector, the private sector ...
is generally reserved for self-employed people and students, and social insurance is normally for corporate employees. National Health Insurance has two categories:
*National Health Insurance for each city, town or village
*National Health Insurance Union
Public health insurance covers most citizens/residents and the system pays 70% or more of medical and prescription drug costs with the remainder being covered by the patient (upper limits apply).
The monthly insurance premium is paid per household and scaled to annual income. Supplementary private health insurance is available only to cover the co-payments or non-covered costs and has a fixed payment per days in hospital or per surgery performed, rather than per actual expenditure.
[ Rapoport-Jacobs-Jonsson 1973, p. 157.]
There is a separate system of insurance (Kaigo Hoken) for long term care, run by the municipal governments. People over 40 have contributions of around 2% of their income.
Insurance for individuals is paid for by both employees and employers. This ends up accounting for 95% of the coverage for individuals. Patients in Japan must pay 30% of medical costs. If there is a need to pay a much higher cost, they get reimbursed up to 80-90%. Seniors who are covered by SHSS ( Senior insurance) only pay 10% out of pocket. As of 2016, healthcare providers spend billions on inpatient care and outpatient care. 152 billion is spent on inpatient care while 147 billion is spent on outpatient care. As far as the long term goes, 41 billion is spent.
Today, Japan has the severe problem of paying for rising medical costs, benefits that are not equal from one person to another and even burdens on each of the nation's health insurance programs. One of the ways Japan has improved its healthcare more recently is by passing the Industrial Competitiveness Enhancement Action Plan. The goal is to help prevent diseases so people live longer. If preventable diseases are prevented, Japan will not have to spend as much on other costs. The action plan also provides a higher quality of medical and health care.
Criticisms
Japanese Ministry of Health, Labour and Welfare is mainly effective, but there are some problems within the system.
Increased access to primary care is one issue that arises. Most citizens in Japan go to the hospital for routine check ups. Primary care needs to be made more readily accessible to Japanese people instead of them going to hospitals for minor health needs. Another issue is Japanese emergency units are below the minimum safe size. The decentralized healthcare system in Japan leads to this inefficiency, because of decentralization the counties are granted an extreme amount of flexibility. The coordination of 47 prefectures is affected because of this constant shifting and flexibility.
In recent years, the health care system of Japan has been heavily criticized for not providing the same quality of health care to all Japanese citizens.
Health issues
This health issues in Japan was especially in the wake of
radiation effects from the
Fukushima nuclear disaster
The was a nuclear accident in 2011 at the Fukushima Daiichi Nuclear Power Plant in Ōkuma, Fukushima, Japan. The proximate cause of the disaster was the 2011 Tōhoku earthquake and tsunami, which occurred on the afternoon of 11 March 2011 and ...
are the observed and predicted effects as a result of the release of radioactive isotopes from the nuclear power plant, caused by the
Tohoku earthquake and tsunami in March 2011. The release of radioactive isotopes from the nuclear reactor containment vessels was a result of venting in order to reduce gaseous pressure, and the discharge of coolant water into the sea. This resulted in Japanese authorities implementing a 30-km exclusion zone around the power plant and the continued displacement of approximately 156,000 people as of early 2013. The number of evacuees has declined to 49,492 as of March 2018. Large quantities of radioactive particles from the incident, including iodine-131 and caesium-134/137, have since been detected around the world.
This health issues in Japan was also especially brought to the light during the
COVID-19 pandemic
The COVID-19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The novel virus was first identif ...
between January 2020 and October 2021 as Japanese media and public health researchers pointed out that 18,000 Japanese people were dying from the virus at the significantly lowest mortality rate than the rest of the population.
See also
*
Health in Japan
The level of health in Japan is due to a number of factors including cultural habits, isolation, and a universal health care system. John Creighton Campbell, a professor at the University of Michigan and Tokyo University, told the New York Tim ...
*
Aging of Japan
Japan has the highest proportion of elderly citizens of any country in the world. According to 2014 estimates, about 38% of the Japanese population is above the age of 60, 25.9% are age 65 or above, a figure that increased to 29.1% by 2022. Pe ...
*
Birth in Japan This article deals with childbirth in Japan, and the specific details of childbirth exclusive to Japan in relation to beliefs, attitudes and healthcare.
Background
History
Legend attributes the creation of Japan to a sun goddess from whom the orig ...
*
Hikikomori
, also known as acute social withdrawal, is total withdrawal from society and seeking extreme degrees of social isolation and confinement. ''Hikikomori'' refers to both the phenomenon in general and the recluses themselves. ''Hikikomori'' ha ...
*
Suicide in Japan
In Japan, is considered a major social issue. In 2017, the country had the seventh highest suicide rate in the OECD, at 14.9 per 100,000 persons, and in 2019 the country had the second highest suicide rate among the G7 developed nations. Ho ...
*
Erwin Bälz
Erwin Otto Eduard von Bälz (13 January 1849 – 31 August 1913) was a German internist, anthropologist, personal physician to the Japanese Imperial Family and cofounder of modern western medicine in Japan.
Biography
The son of a contr ...
—a
foreign government advisor and cofounder of modern medicine in Japan
*
Health care compared
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...
—tabular comparisons with the U.S., Canada, and other countries not shown above
*
List of hospitals in Japan
There were 8,372 hospitals in Japan in October 2018. The largest number of hospitals were in Tokyo with 650 hospitals.
Aichi Nagoya
*Aichi Cancer Center Hospital - Chikusa-ku, Nagoya
*Aichi Saiseikai Hospital - Nishi-ku, Nagoya
*Chubu Rosai ...
*
Public health centres in Japan
In Japan, a public health centre (Japanese: 保健所 ''Hokenjo'') is a government facility responsible for public health matters.
The primary role of public health centre is to prevent infectious disease and chronic health problems. It is respo ...
*
Social welfare in Japan
Social welfare, assistance for the ill or otherwise disabled and the old, has long been provided in Japan by both the government and private companies. Beginning in the 1920s, the Japanese government enacted a series of welfare programs, based mai ...
*
Timeline of healthcare in Japan
A timeline is a display of a list of events in Chronology, chronological order. It is typically a graphic design showing a long bar labelled with calendar date, dates paralleling it, and usually contemporaneous events.
Timelines can use any ...
Bibliography
;Notes
;References
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